Farmer Registration Form – Agronomics Indian Farmers Producer Company Limited

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Farmer Registration Form

AIFPCL Farmer Registration Form

Farmer Name

.

.

Father Name

.

.

Mother Name

.

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Date Of Birth

Gender

Permanent Address

Address Line 1

Address Line 2

City

State

Zip Code

Country

Correspondent Address

Address Line 1

Address Line 2

City

State

Zip Code

Country

Aadhar Number

Pan Card Number

Contect Number

Email

Identification Mark

Numer of Shares Applied For

Value per Share(—)

Total Amount Payable with Processing fee and welfare fee,(Processing fee not refundable.)

Payment Details

Total Land Owned ( in Hectares/Acres)

Primary Crops/Produce

List of input requiirements(Seeds,Fertilizer,etc)

I have read and agree to the Terms and Conditions and Privacy Policy

I consent to have this website store my submitted information so they can respond to my inquiry

I certify that I am a primary producer and agree to abide by the Memorandum of Association (MoA) and Articles of Association (AoA) of the Company

Nominee Name

Signature/Thumb Impression of Farmer

Date / Time

Verified by Director/Authorized Representative